ADMISSION FORM Serial No... GURU ANGAD DEV VETERINARY AND ANIMAL SCIENCES UNIVERSITY LUDHIANA 141004 ADMISSION FORM FOR COUNSELLING FOR ADMISSION TO DIPLOMA IN VETERINARY SCIENCE AND ANIMAL HEALTH TECHNOLOGY (ACADEMIC SESSION 2017-18) Important: The candidate must carefully read instructions given at the end of this form and in the prospectus before filling the form. Last Exam Passed Name of Board / University For Office use only Marks/OCPA/OGPA obtained % age of marks Latest passport size photograph pasted with gum duly signed by the candidate. Category under which seeking admission.... Documents lacking...... Checked by..... Re-checked by......... Fees paid `...... Cashier....A.O.... Admission No.... Admission Status..... Assistant... Supdt... Asstt. Registrar... To be filled by the candidate in his/her own handwriting with blue/black ink 1. Name of the applicant (in block letters)... 2. Father's name (in block letters).... 3. Mother's name (in block letters)... 4. (a) Permanent Address:......... (b) Correspondence Address:.......... (c) Telephone No. with code No..... Mobile No... E-mail... (d) Aadhaar Card No.... (e) Roll No. of Entrance Test... 1 Contd...
5. Place of residence (attach certificate as per Annexure VIII/IX)... 6. Reserved category (ies) under which admission sought... (SC/ST/BC/SP/FF/AF/TA//DP/KJR) Bring the original as well as the attested copy (ies) of the certificates as applicable in Annexure I to VI at the time of counselling/ interview in support of your claim, otherwise, it will not be considered for admission. 7. Date of Birth.... (As entered in the matriculation or equivalent certificate). Attach attested copy 8. Nationality.... 9. (a) Name of father or guardian with relation.... (b) Occupation of father/guardian.... (c) Annual income of the father/guardian.... (d) Address of father/guardian............ 10. Have you ever been dropped/expelled/rusticated or denied.... admission to any school or college? If yes, give detailed... reasons and period of dropping/expulsion/rustication..... 11. Have you ever been found guilty of adopting unfair means... in any examination or disqualified/ barred from appearing.... in any examination conducted by any Board/University? If yes, give details. 12. Detail of examination (s) passed: Examination Matriculation 10+2 Name of School Name of the Board Month and Year of passing Board Roll No. Maximum Marks Marks Obtained Percentage of Marks Medium of Instruction Subject Biology Total Marks Marks obtained Subjects Physics Chemistry English 2
DECLARATION BY CANDIDATE 1. I son/daughter of Sh. hereby certify that the application form has been filled in my own hand writing with blue /black ball point and according to the given instructions. 2. I hereby affirm that the information given by me in this application form is complete and true to the best of my knowledge and belief and that I have made this application with the consent and approval of my parent/guardian. In the event of my admission to the college, I undertake to abide by the disciplinary and other rules and regulations of the college and the university. 3. If the information provided by me is found to be incorrect, I will be liable to be prosecuted under law and summarily expelled from GADVASU. Place. Date. (Signature of candidate) DECLARATION BY PARENT/ GUARDIAN I. do hereby declare that my son/daughter/ward. makes this application with my knowledge and consent and that in the event of his/her being admitted to the college, I shall be responsible for his/her good conduct and for the due and prompt payment of college and other fees and to indemnify the college/university in respect of all losses and the expenses resulting from delay and failure to make any such payment or as a result of the particulars given above proving incorrect. Place. Date.. (Signature of Parent/Guardian) Name. Address.. 3
INSTRUCTIONS 1. The Candidate must ensure his/her eligibility (from the prospectus) before filling up the form. 2. The application form must be filled LEGIBLY IN BLUE/BLACK BALL POINT IN CANDIDATE'S OWN HANDWRITING and submitted in person at the time of counselling. 3. Latest passport size photograph from the same negative duly signed by the candidate should be pasted in the space provided on the application form. These photographs should be the same in all respects as the candidate wishes to appear in the counselling, if he/she wishes to appear with beard, turban, etc, photograph should appear so. 4. The application form must be completed and no column should be left blank. Write not applicable where no information is required to be given. Incomplete application form is liable to be rejected. 5. Self attested copies of all the certificates from matriculation onward and other supporting testimonials must be attached with white application form in the first instance. No addition certificate/testimonial shall be entertained subsequently. 6. The Registrar may, at his discretion, cancel the admission of a candidate if at any time, it is found that the candidate obtained admission by misrepresentation/concealment of facts or the admission was made due to error oversight, etc. List of Self Attested copies of Certificates/Testimonials to be Attached with the application form 1. Certificate as evidence of belonging to reserve category(ies) (Annexure -I to VI). 2. Certificate as evidence of an outstanding sportsperson. 3. Declaration of Parents/ Guardian (Annexure -VII). 4. Certificate of residence (Annexure -VIII/IX). 5. Certificate as evidence of date of birth. 6. Detailed marks certificate of all the parts of the examination (s) which qualifies the candidate for admission. 7. Character certificate from the Principal of School/College last attended. 8. Low income certificate from competent authority in the prescribed format (Annexure X) for SC candidates whose parent's annual income from all sources is less than rupees 2.5 Lac. 9. Self undertaking of gap in study, if applicable (Annexure -XI). Note: (i) Original Certificates/Testimonials etc. of self attested copies of which have been enclosed with the Admission Form should be produced at the time of counselling. (ii) If electronically generated detailed marks certification/copy of gazette of 10+2 is produced at the counseling, it should be attested by the Principal of the school last attended. 4
ANNEXURE I CERTIFICATE FOR SCHEDULE CASTES/SCHEDULED TRIBES (SC/ST) Dispatch No. Date: 1. It is certified that Shri/Smt./Kumari son/daughter of Shri of village/ town District/ Division State of Punjab belongs to Caste which has been recognized as Scheduled Caste as per The Constitution (Scheduled Castes) Order, 1950 2. Shri/Smt./Kumari and his/ her family lives in village/town District/Division of Punjab State. Place Signature Date Designation (Seal of office) Authority competent to issue SC/ST Certificate: i) District Magistrate / Additional Distt. Magistrate / Deputy Commissioner / Additional Deputy Commissioner / First Class Stipendiary Magistrate / Sub Divisional Magistrate / Executive Magistrate. ii) Revenue Officer not below the rank of Tehsildar. N.B.: In case the certificate is found to be false or incorrect, the candidate will render himself/ herself liable for criminal prosecution.
ANNEXURE- II (a) CERTIFICATE IN SUPPORT OF CLAIM OF BELONGING TO BACKWARD CLASS (BC) 1. This is certified that Mr./Ms......... son/daughter of Shri...village/ town......in District/ Division......of State of Punjab, belongs to the... caste which is recognized as a Backward Class in term of Punjab Government letter No...... 2. This is also verified that income of the family from all sources does not exceed `6,00,000/- ( Rupee Six Lakh only) per annum in terms of letter No. 1/41/93-RC-1/609 dated 24-10-2013 from Department of Welfare, Government of Punjab, Chandigarh. 3. Shri/Smt./Kumari... and/or his/her family ordinary resides in village/town. of District/Division of the State of Punjab. Place Signature.... Date. Designation.. (with seal of office) Authorities competent to issue BC Certificate: Deputy Commissioner, Additional Deputy Commissioner, Sub-Divisional Magistrate, Executive Magistrate (PCS Officer only), Tehsildar. N.B.: i) In case the certificate is found to be false or incorrect, the candidate will render himself/ herself liable for criminal prosecution. ii) The certificate must not be dated one year before the first day of counselling for admission. A certificate issued more than one year before the counselling date shall not be valid.
ANNEXURE- II (b) OFFICE OF THE TEHSILDAR... Low Income Certificate (for Applicants of BC category only) No... Date... It is certified that according to the regional establishment, the annual income of the whole family of Sh. / Smt. / Kumari...S/O. / D/O. / Wife/O., resident of Village...Post office...tehsil... District...(Punjab), is Rupees... TEHSILDAR
ANNEXURE- III CERTIFICATE TO BE FURNISHED BY THE CHILDREN/ GRAND CHILDREN FREEDOM FIGHTER (FF) Certified that Shri/Smt./Kumari... an applicant for admission to Diploma in Veterinary Science and Animal Health Technology programme at Guru Angad Dev Veterinary and Animal Sciences University, Ludhiana is a son/daughter/son's son /daughter's daughter (delete whichever is not applicable) of Shri... who is freedom fighter/tamra Patra holder and/or drawing pension form... treasury as per Punjab Govt. Rules/Instructions wide letter no.... dated... Place Signature.... Date. Designation.. (with seal of office) Authority competent to issue F/F Certificate: Deputy Commissioner / Additional Deputy Commissioner / G.A. to Deputy Commissioner of the district to which the freedom fighter belongs. N.B.: In case the certificate is found to be false or incorrect, the candidate will render himself/ herself liable for criminal prosecution.
ANNEXURE-IV (A) CERTIFICATE TO BE FURNISHED BY THE CANDIDATE IN SUPPORT OF CLAIM OF BEING CHILD OF IN-SERVICE OR EX-SERVICEMEN IN ARMED ORCES/C.R.P.F./ B.S.F. OFFICERS/ OFFICIALS (INCLUDING OFFICERS/OFFICIALS WHO DIED DURING THEIR SERVICES) (A/F) Certified that Mr./Ms....... Son/Daughter of Sh...... resident of...... is Father/Mother/Guardian of Mr./Ms.......... has been/is i) Serving Defence Personnel/Ex-serviceman ii) Killed in action iii) Released / Retained vide Order No....... Dated.... iv) Died while in service and death attributed to Military Service. This certificate is being issued for admission purpose only to Mr./Ms...... to apply for admission to Diploma in Veterinary Science & Animal Health Technology at Veterinary Polytechnic, Kaljharani Place Signature & Seal of the Commanding Officer/ Date. Secretary Distt. Sainik Welfare Board Note : The candidate seeking admission under above category should produce a certificate from Army Headquarter or the commanding officer of the unit in which the Father/Mother of the candidate is serving. In case of Ex. Armyman the certificate must be signed by the Secretary Distt. Sainik Welfare Board. ANNEXURE - IV (B) THE CERTIFICATE TO BE FURNISHED BY CHILDREN/WARD OF PUNJAB POLICE PERSONNEL, PUNJAB ARMED POLICE/PUNJAB HOME GUARD WHO DIED DURING SERVIC OR DISABLED TO THE EXTENT OF 50% OR MORE IN ACTION WINNERS OF PRESIDENTS POLICE MEDAL FOR GALLANTARY OR POLICE MEDAL FOR GALLANTRY (AF) Certified that Mr./Ms..... Son/Daughter....of Sh./Smt.... was/is dependent of Mr./Ms.... Son/Daughter of Mr./Ms.. who was killed / 50% or more disabled in action which took place at on decorated with President/Police Medal for Gallantry / Winner of Police Medal for Gallantry is a ward of Punjab Police Personnel / Punjab Armed Police / Punjab Home Guard / Para Military Force Personnel. Date. Signature of IG Police (HQ) Punjab N.B.: In case the certificate is found to be false or incorrect, the candidate will render himself/ herself liable for criminal prosecution.
ANNEXURE-V CERTIFICATE TO BE ISSUED BY THE SUB-DIVISIONAL OFFICER (CIVIL) IN RESPECT OF INNOCENT CIVILIANS KILLED/100% PHYSICALLY INJURED BY TERRORIST/SECURITY FORCES ACTING IN AID OF CIVIL POWER (TA) 1. It is certified that Shri/Smt./Kumari son/daughter/wife of Sh./Smt. resident of (Name of Village, Tehsil (in case the deceased belonged to rural area) house number, name of mohalla and area of town to which he/she belongs) was killed/100% physically disabled by the terrorists/security forces acting in aid of civil power on in village/ mohalla Tehsil/Town District He was neither terrorist nor having any links with such elements. 2. This certificate is being issued for admission purpose only to Shri/Smt./Kumari to apply for admission to GADVASU, Ludhiana. Place Date Signature Designation (Seal) Authority competent to issue TA Certificate: Deputy Commissioner / Additional Deputy Commissioner / G.A. to Deputy Commissioner of District N.B.: In case the certificate is found to be false or incorrect, the candidate will render himself/ herself liable for criminal prosecution.
ANNEXURE-VI CERTIFICATE TO BE PRODUCED IN SUPPORT OF CLAIM OF DISABILITY BY DISABLED PERSONS (DP) No Date It is certified that Shri/Smt./Kumari age about years son/daughter of resident of Tehsil District has been examined by Dr. or a Medical Board of Civil Hospital consisting of Dr., Dr. Dr. & Dr.. The medical report is as under :- Name of the Disease Whether the Disease is progressive / non progressive Whether the candidate is fit to carry on studies He/She is physically handicapped and his/her disability is % His/Her signatures are given below: Photograph pasted with gum and then attested by the Civil Surgeon of the District. Signature Designation (with seal of office) Signature of the Candidate Authority competent to issue DP Certificate: 1. Civil Surgeon through a Medical Board consisting of at least 3 members out of which one shall be specialist in the particular field for assessing locomotor /cerebral / Visual / hearing disability as the case may be in case of multiple disability. 2. Single specialist doctor for single disability. N.B.: In case the certificate is found to be false or incorrect, the candidate will render himself/ herself liable for criminal prosecution.
ANNEXURE- VII SELF DECLARATION * SELF DECLARATION OF THE PARENTS /GUARDIAN Latest Passport Size Photograph of declarant I.... Father/Mother/Guardian of Miss/Mr..... Resident of (Full address to be given)......do, hereby, solemnly state and affirm as under : 1. That I am a citizen of India. 2. That neither the declarant nor the child/ward of the declarant has obtained the benefit of Residence in any other state. Dated.. DECLARANT Verification: Verified that the contents of my above declaration are true and correct to the best of my knowledge and belief and nothing has been concealed thereof. Dated DECLARANT -----------------------------------------------------------------------------------------------------------------------------------------
ANNEXURE-VIII RESIDENCE CERTIFICATE (SPECIMEN FORMAT) **CERTIFICATE TO BE ISSUED BY THE PRINCIPAL/HEAD MASTER OF THE GOVERNMENT/ RECOGNISED SCHOOL/COLLEGE CONCERNED IN CASE OF CATEGORY(i) It is certified that Miss/Mr D/o/S/o Sh has been a student of this School/College for a period of years, from to He/She left the School/ College on Date Signature of Principal/Head Master of the School/College(Seal) **CERTIFICATE TO BE ISSUED BY HEAD OF DEPARTMENT IN CASE OF CATEGORY (ii) (a) Certified that Mr./Miss S/o/W/o Sh Father/mother of Miss/Mr (name of the Child/Ward) is an employee of the (name of office) of Punjab Government. He/She is working as and is posted at He/She has more than three years service at his/her credit. Date Place Head of Department (Seal) Certified that Mr./Ms S/o/W/o Sh is father/mother of Miss/Mr. is an employee of the of Punjab Government. He/She is working as on deputation with the and is posted at He/She has more than three years service at his/her credit. OR Place Date Head of the Department (Seal) **CERTIFICATE TO BE ISSUED BY THE RESPECTIVE HEAD OF THE DEPARTMENT IN THE CASE OF CATEGORY (ii) (b) Certified that Mr./Ms S/o/W/o Sh is father/ mother of Miss/Mr is an employee of the Govt. of India and he/she is working as He /She has been posted at Chandigarh/Punjab in connection with the affairs of Punjab Government for the past three years. Head of the Department Date (Seal)
**CERTIFICATE TO BE ISSUED BY THE RESPECTIVE HEAD OF THE DEPARTMENT IN THE CASE OF CATEGORY (ii) (c) Certified that Mr./Ms.S/o/W/o Sh is father/mother of Miss/Mr. is an employee of the of (Institution/Undertaking) of the Government of Punjab and is working as He /She has been posted at Chandigarh/Punjab in connection with the affairs of Punjab Government for the past three years Date Head of the Department (Seal) **CERTIFICATE TO BE ISSUED BY THE RESPECTIVE HEAD OF THE DEPARTMENT IN THE CASE OF CATEGORY (ii) (d) Certified that Mr./Ms S/o/W/o Sh is father/mother of Miss/Mr. is an employee of the (name of autonomous body/company) in which the Punjab Government has 20% or more share. He/She is working as and is posted at It is also certified that he/she has three years of service in the above said autonomous body/company. Date Head of the Department (Seal) **RESIDENCE CERTIFICATE TO BE ISSUED BY THE DC, ADC(R), ADC (D), SDM, ASSTT. COMMISSIONER GENERAL, DORG, DRO, EM, TEHSILDAR, COMMISSIONERS OF MUNICIPAL CORPORATIONS OF AMRITSAR, JALANDHAR, PATIALA AND LUDHIANA IN CASE OF CATEGORY (iv). Certified that Mr/Mrs. S/o/W/o Sh. father/mother/guardian of Mr./Miss (name of the Child/Ward with full address) has settled* in Punjab or has resided* in Punjab for a period of 5 years from to He/She is working as *Strike out whichever is not applicable. (name of profession, designation and job). Date Signature of DC, ADC (R), ADc (D), SDM, Asstt. Commissioner General, DORG, DRO, EM, Tehsildar, Commissioners of Municipal Corporations of Amritsar, Jalandhar, Patiala and Ludhiana.
**RESIDENCE CERTIFICATE TO BE ISSUED BY THE DC, ADC(R), ADC (D), SDM, ASSTT. COMMISSIONER GENERAL, DORG, DRO, TEHSILDAR BASED ON COPIES OF JAMABANDHI, REVENUE RECORD, MUNICIPAL RECORDS, REGISTERED DEED OR ANY OTHER DOCUMENT TO THE FULL SATISFACTION OF THE DC IN CASE OF CATEGORY (v). Certified that Mr/Mrs. S/o/W/o Sh. father/mother/guardian of Mr./Miss (name of the Child/Ward with full address) hold immovable property at (place & district) in the state of Punjab for the past years. Date Signature of DC, ADC (R), ADC (D), SDM, Asstt. Commissioner General, DORG, -Tehsildar, based on copies of Jamabandhi, Revenue Record, Municipal Records, Registered deed or any other document to the full satisfaction of the DC. **RESIDENCE CERTIFICATE TO BE ISSUED BY THE DC, ADC(R), ADC (D), SDM, ASSTT. COMMISSIONER GENERAL, DORG, DRO, EM, TEHSILDAR, COMMISSIONERS OF MUNICIPAL CORPORATIONS OF AMRITSAR, JALANDHAR, PATIALA AND LUDHIANA IN CASE OF CATEGORY (vi). Certified that Miss/Mr. S/o/D/o Sh. resident of was born in Punjab as per Birth Certificate. Date Signature of DC, ADC (R), ADc (D), SDM, Asstt. Commissioner General, DORG, DRO, EM, Tehsildar, Commissioners of Municipal Corporations of Amritsar, Jalandhar, Patiala and Ludhiana. * ** This declaration is to given by all candidates. Any one of these certificates, as applicable to the candidate according to the Punjab Govt. Instructions, is to be given.
ANNEXURE- IX OFFICE OF THE TEHSILDAR, BATHINDA BONAFIDE CERTFCATE FOR THE PERMANENT RESIDENTS OF KALJHARANI (for Applicant of Kaljharani only) No. Tehsildar Bathinda Dated.... Certified that Shri/Smt/Miss... Son/Daughter/Wife of......is permanent resident of Village KALJHARANI, Tehsil Bathinda, District Bathinda, Punjab. Further Certified that the Certificate has been issued in accordance with Punjab Govt. Instructions contained in Letter No.1-3-95/3 PP-II / 9619 dated 6-6-96 and is covered under Category No... of the said letter. Tehsildar
ANNEXURE-X OFFICE OF THE TEHSILDAR... Low Income Certificate (for Applicants of SC category only) No.... Date... It is certified that according to the regional establishment, the annual income ot the whole family of Sh. / Smt. / Kumari...S/O / D/O./ Wife/O... resident of village...post Office...Tehsil... District...(Punjab), is less than Rupees... TEHSILDAR
ANNEXURE XI SELF UNDERTAKING OF GAP IN STUDY PERIOD I Son/daughter of resident of (full address to be given) do hereby solemnly declare and affirm as under : 1. That I have passed 10+2 examination held in from (School/College) 2. That I have not joined any college/institution after passing 10+2 OR That I have joined the course at (Name of the institution) w.e.f. and will leave the same before joining the Diploma in Vety. Science and Animal Health Technology. Dated : Signature of the Candidate